Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions

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Background: The main objective of this research is to identify, categorize, and analyze barriers perceived by physicians to the adoption of Electronic Medical Records (EMRs) in order to provide implementers with beneficial intervention options.

Methods: A systematic literature review, based on research papers from 1998 to 2009, concerning barriers to the acceptance of EMRs by physicians was conducted. Four databases, "Science", "EBSCO", "PubMed" and "The Cochrane Library", were used in the literature search. Studies were included in the analysis if they reported on physicians' perceived barriers to implementing and using electronic medical records. Electronic medical records are defined as computerized medical information systems that collect, store and display patient information.

Results: The study includes twenty-two articles that have considered barriers to EMR as perceived by physicians. Eight main categories of barriers, including a total of 31 sub-categories, were identified. These eight categories are: A) Financial, B) Technical, C) Time, D) Psychological, E) Social, F) Legal, G) Organizational, and H) Change Process. All these categories are interrelated with each other. In particular, Categories G (Organizational) and H (Change Process) seem to be mediating factors on other barriers. By adopting a change management perspective, we develop some barrier-related interventions that could overcome the identified barriers.

Conclusions: Despite the positive effects of EMR usage in medical practices, the adoption rate of such systems is still low and meets resistance from physicians. This systematic review reveals that physicians may face a range of barriers when they approach EMR implementation. We conclude that the process of EMR implementation should be treated as a change project, and led by implementers or change managers, in medical practices. The quality of change management plays an important role in the success of EMR implementation. The barriers and suggested interventions highlighted in this study are intended to act as a reference for implementers of Electronic Medical Records. A careful diagnosis of the specific situation is required before relevant interventions can be determined.



The implementation of Electronic Medical Records (EMRs) has suffered from low usage by physicians. Refer to EMR Implementation. A study was conducted to determine the barriers causing slow adoption rates and to identify suggestions to overcome these barriers. This would allow implementers to analyse ways available to improve the rollouts of EMRs.[1]


The study was performed using four different types of publications that were published between 1998 - 2009. A selection process was created to determine which articles would be used (which summed up to twenty-two at the end). A classification system was developed to assist in documenting barriers identified: Financial, Technical, Time, Psychological, Social, Legal, Organizational, and Change Process.

Result Highlights

The study revealed two different barriers: primary (first level physicians exposure to) and secondary (not directly impacted but maybe be integrated in primary barriers). Practice size influenced the type of barrier presented for the rollout of EMRs. It was noted that Organizational and Change Process classifications were imbedded with the other barriers.

Conclusion / Summary of Key Points

The study reviewed the reasons that physicians were slow to utilize EMRs. It concluded that implementations significantly impacted ways of working. The analysis from the study showed that Organizational and Change management processes facilitate the rollout of EMR implementations.


After reviewing the article, the significance of the Change Process outlined seem to be one of the most critical factors in contributing the success of EMR implementation adaptability. Major project rollouts usually tend to place a high priority on development and tend to squeeze change management tasks towards the end of project implementations.


  1. Boonstra, Broekhuis, 2010. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions

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